Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis

Abstract

Background Achieving undetectable viral load is crucial for the reduction of HIV transmissions, AIDS-related illnesses and death. Adolescents (10 to19 years) living with HIV (ALHIV) on antiretroviral treatment (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among ALHIV in the Ehlanzeni district, Mpumalanga in South Africa. Methods A cross-sectional analysis was conducted with 9386 ALHIV, aged 10 to 19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). ALHIV were categorised as having achieved viral suppression if their latest viral load count was < 1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression. Results The mean age of the participants was 14.75 years (SD = 2.9), and 55.43% were female. Mean duration on ART was 72.26 (SD = 42.3) months. Of the 9386 adolescents with viral load results recorded, 74% had achieved viral suppression. After adjusting for other covariates, the likelihood of achieving viral suppression remained significantly higher among ALHIV who were: female (AOR = 1.21, 95% CI 1.05–1.39), and had most recent CD4 count > 200 (AOR = 2.53, 95% CI 2.06–3.11). Furthermore, the likelihood of having viral suppression was lower among adolescents with CD4 count > 200 at baseline (AOR = 0.73, 95% CI 0.61–0.87), and who were switched to second line regimen (AOR = 0.41, 95% CI 0.34–0.49). Conclusions Viral suppression amongst ALHIV at 74% is considerably lower than the WHO target of 95%. Of particular concern for intervention is the lower rates of viral suppression amongst male ALHIV. Greater emphasis should be placed to early enrolment of ALHIV on ART and keeping them engaged in care (beyond 6 months). Furthermore, improved and regular viral load monitoring will help to adequately identify and manage ALHIV with unsuppressed viral load and subsequently switching to second line treatment.

Viral suppression among adolescents on HIV treatment in the Sedibeng District, Gauteng province

“…The viral suppression rate of adolescents on ART at the Levai Mbatha CHC was 74.0%, which fell short of the UNAIDS target of 90%. Similar results were reported in Ehlanzeni district, in Mpumalanga province, South Africa (Okonji et al 2021 ), with a viral suppression rate of 74.3%. However, the suppression rate of this study was higher compared to that in Uganda at 65.5% (Natukunda et al 2019 ).…”

“…The high number of older adolescents in this study may be influenced by the aging of perinatally infected infants who entered HIV care in childhood and an increasing number of older adolescents seeking care who were probably infected through sexual transmission (Maskew et al 2019 ). Additionally, the high viral suppression rate among adolescents aged 15–19 years could be because they are able to take their ART medication regularly without supervision and possess self-competence on ART adherence (Okonji et al 2021 ).…”

Factors associated with viral suppression among adolescents on antiretroviral therapy in Free State province, South Africa

“… 3 However, in the Eastern Cape and Mpumalanga, in settings reflecting conditions similar to those reported in the current paper, 71% of adolescents in the Eastern Cape and 74% of those in Mpumalanga were virally suppressed in the past 12 months. 19 , 20 Our study extends the evidence in support of an optimised adolescent HIV care cascade for all South African ALHIV across all healthcare facilities. 21 …”

Implementation of a Psychosocial Support Intervention for Adolescents on Antiretroviral Treatment: Challenges and Experiences from Ehlanzeni District, South Africa

“…The study was conducted in five public primary health care facilities, namely Buffelspruit clinic, Kanyamazane CHC, Cunningmore clinic, Langloop CHC and Naas CHC. Our baseline study in the Ehlanzeni district found a 74% viral suppression rate (confidence interval: 73.1%-74.8%) among ALHIV on antiretroviral treatment in 2019, 12 and retention in care rates at 6, 12, 18 and 24 months of 90.5%, 85.4%, 80.8% and 76.2%, respectively 13 – which fail to meet the UNAIDS target of 95%, 95%, 95% by 2030.…”